TRADITIONAL, NOT CONVENTIONAL.

Medical Insurance Tricks(September 29, 2015)

Few doctors have ever loved the medical insurance system. And as time passes, more and more patients are joining our ranks. We are haters, and we are not ashamed of it. Medical insurance and reimbursement gets loonier and less responsive to its customers every year, not to mention more expensive. What's to like?

But this wasn't always true. It used to be very simple and straightforward. Back in the old days, when I didn’t have to worry about a skin care regimen, some people didn’t have insurance – you sent them a bill and they paid it. Some people DID have insurance – you sent the bill to the insurance company instead and, after a little whining and a few extra weeks of delay, THEY paid it. It's not that way anymore, as you probably know. (If you didn't know -- consider yourself warned.)

Big institutions, large medical groups, and other organizations that do a lot of high-priced medical procedures grouse about insurance, but secretly they know that they couldn’t do what they do – and charge what they do – if patients had to pay their own bills. So they complain, but they know perfectly well that they only exist because insurance exists. This is not the case for individual doctors anymore. We exist now in spite of insurance companies. Those of us who are still around, anyway.

If you have been in my office recently, you already know that I do not “accept insurance”, as the saying goes. That is because if I had to jump through insurance company hoops to get paid, or hire someone else to do so, I would have to charge twice as much as I do now. There is not a doctor’s office out there now that "accepts insurance" that doesn’t spend more time handling paperwork than it does directly serving their patients.

Anyone who has tried to work with their insurance company probably knows from experience why I don’t file that paperwork myself anymore. You get delays, then rejections due to stupid reasons, then more delays and more rejections due to other stupid reasons, and at the end of it all you often find out that the amount they have grudgingly allotted you just goes toward your deductible anyway.

This all, as a friend of mine says… well, I’m not going to write that here. It is a very crude expression involving animals and intimate activity. But you get the idea.

That said, it it is not only risky to have no medical insurance these days, it is actually often Against The Law. Who ever woulda thunk THAT? So now medical insurance is a grim and inevitable part of life, like road construction and root canals. And, to make things even harder for people, there are more and more medical offices abandoning insurance filing all together. Mostly the small ones that pay a lot of attention to their patients. You know, the offices that you might actually WANT to go to when you have a scary problem.

So patients (a group that most of us will be part of at one time or another) are going to have more, rather than less, contact with their medical insurance companies in the foreseeable future. This is the reason that I have gathered together a few suggestions to help you navigate these choppy new waters. This advice has been gathered from personal experience and from the experience of a few other people, providers and patients both. May it help you through the next few years. Because it can’t stay like this forever, can it?

-- Make sure you know your insurance plan inside and out. YOU. The days of letting your doctor’s office handle everything are long gone unless you are willing to pay dearly in both dollars and health for that privilege. Companies vary, and plans within the same company vary even more. Know what cards YOU’ve been dealt.

-- Do not be afraid to call your insurance company and ask questions before you get a service, if you don't understand a bill, or for absolutely any other reason under the sun. There are no stupid questions, only stupid people, and stupid people don’t ask questions. This is your money (and maybe your health) we're talking about here. Who to call? There is an 800 number right there on your insurance card that they give you to call with any questions.

-- Call anyone who sends you a bill that looks at all weird. You don’t have to be mean. Just find out what the deal is.

-- If the person you talk to can't answer your question, find out who can. Write down their name and phone number before you let yourself be transferred to them. And that brings us to...

-- …Document everything. This applies to what your insurance company tells you on the phone, but also to doctor office visits, hospital stays, etc. etc. as well. Who you talked to and when, what they did and what they told you, names dates and times, and particularly any information given to you that leads you to make a decision as to a procedure or other action.

-- Never pay till the third bill. The first couple of months after you incur an expense, your providers and insurance company are dueling over who pays and how much, and if you send a check in too quickly somebody might decide that that lets THEM off the hook. Except that...

-- ...this really does not apply to individual doctor's offices. And this is why. If you have scored a real relationship with a real doctor (a rare thing these days) you want to stay right on top of that bill and pay it, if not immediately, certainly as soon as they tell you insurance has paid all that it's going to. A good primary care practitioner (M.D., chiropractor, pediatrician, dentist, etc.) is the most valuable partner you can have right now in navigating the medical and the insurance systems. THEM you don't want to take a chance with.

-- Even for the faceless institutions, however, you might want to call after you get the second bill and see how things are going. This is where you might find out that something was coded wrong or went to the wrong department or that A hasn’t returned B’s call, or something, and you can step in and grease the wheels, so to speak.

-- The imaging places, labs etc. that are really on top of things often give you an estimate at your time of service of what you will probably have to pay for that service, and offer you a discount if you’ll pay that immediately. Do it. "Discount" being the key word here.

-- An expense that is completely outside of the scope of your insurance (or if you don’t have insurance at all) can be dickered over. Don't be embarrassed -- the rest of the world does this all the time. Find out what Medicare would pay for that service, and offer them the Medicare cost in payment. This works even better before you incur the expense, but it works afterwards as well. This tip was given to me from a personal injury attorney and I’ve been told that it’s priceless.

-- If all else fails and you are being blatantly screwed over by your insurance company, drag the government into it. That's right. Nothing puts the fear of god into every company out there (except Comcast) like the possibility of the government looking into their practices. In Tennessee start with these phone numbers: (615) 741-2218 or (800) 342-4029. (Consumer Insurance Services for the State of Tennessee.)

I must repeat. If you are going to even begin to get benefit from your insurance premiums, you have to be on top of things every step of the way now. This is especially rotten if you are sick and there is no one to help you, but that is the present state of our system, so be prepared. Ahead of time if possible.

This is going to get worse for a while, and soon. There are a lot of new rules coming into play in the near future at the same time that a lot of bugs are being ironed out of a system with many new players in it. So stay healthy (always the best first step anyway) and know your insurance and don't be afraid to PUSH when you have to. And good luck in our brave new world of, ah, "health" care.